UV-A radiation is associated with accelerated skin aging, while UV-B exposure is associated with sunburns.1 Exposure to both types of radiation is a major risk factor for the development of skin cancer.1 By protecting the skin from UV light, sunscreen protects against these negative sequelae of sun exposure.2- 4 In 2011, the US Food and Drug Administration announced new regulations for sunscreen labels to emphasize the importance of protection against both UV-A and UV-B radiation, now known as broad-spectrum protection.5,6 In this survey study, we assessed consumer comprehension of sunscreen labels and knowledge of general sun protective behaviors.

Methods

Following approval by the Northwestern University Institutional Review Board, 114 participants who attended the Northwestern Medicine dermatology clinic between June 1 and August 31, 2014, and gave verbal consent were anonymously surveyed. Participants were asked to answer questions regarding their demographics, Fitzpatrick skin type, sunscreen purchasing behaviors, and understanding of the language commonly used on sunscreen labels. Associations between 2 factors were assessed using the Yates χ2 test with P = .05 considered significant.

Results

The results of our analysis are summarized in Table 1 and Table 2. Most participants (93 [81.6%]) had purchased sunscreen in 2013, by which time sunscreen products with updated labels were readily available to consumers. Eighty-six participants (75.4%) identified prevention of sunburns as an important factor in their decision to wear sunscreen, followed by preventing skin cancer (75 participants [65.8%]). The top 3 influences in the participants’ decisions to purchase a particular sunscreen were highest sun protection factor (SPF) value (56 participants [49.1%]), sensitive skin formulation (54 [47.4%]), and water and sweat resistance (49 [43.0%]). Only 39 participants (34.2%) indicated the broad-spectrum designation as an important factor in their purchasing decision.

Next, sunscreen label comprehension and general knowledge about sun protection were assessed. Fewer than half of the participants were able to correctly identify the terminology that indicated how well the sunscreen protected against skin cancer (43 [37.7%]), photoaging (8 [7.0%]), and sunburns (26 [22.8%]). Furthermore, only 49 participants (43.0%) understood the definition of the SPF value. While most participants correctly identified higher SPF values as correlated with increased protection against sunburns (105 [92.1%]) and skin cancer (82 [71.9%]), only 33 (28.9%) understood that it does not directly confer protection against photoaging. Most participants (93 [81.6%]) understood that sun avoidance is superior to sun protection in skin cancer prevention. Interestingly, participants who indicated “highest SPF available” as an important factor in their sunscreen purchasing decision were less likely to answer this question correctly compared with those who did not consider SPF value to be an important factor (P < .05). Furthermore, only 63 participants (55.3%) correctly identified the amount of sunscreen needed to cover the entire body in order to achieve the advertised level of sun protection.

Finally, participants were presented with a sunscreen label that designated UV-A protection as a star rating system (out of 4 stars) and UV-B protection as an SPF value. When given this sunscreen label, most participants were able to correctly determine the level of UV-A (90 [78.9%]) and UV-B (101 [88.6%]) protection.

Discussion

Despite the recent changes in labeling mandated by the US Food and Drug Administration, this survey study suggests that the terminology on sunscreen labels may still be confusing to consumers. Furthermore, consumers may hold misconceptions about the factors important in a sunscreen, including a common overreliance on the SPF value. There is an ongoing need for physicians to educate their patients about the need for protection against both UV-A and UV-B radiation in preventing skin cancer and sunburns.

A new metric may be needed to better reflect the performance of current sunscreens. Given that the majority of participants were able to correctly interpret a sunscreen label in which UV-A and UV-B protection were separately designated, this approach seems promising for its use in improving consumer understanding of sunscreen labels and their ability to make informed sunscreen purchasing decisions.

Author Contributions: Dr Kundu had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis.

Study concept and design: Sheu, Kundu.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Kong.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Kong.

Administrative, technical, or material support: All authors.

Study supervision: Kundu.

Conflict of Interest Disclosures: None reported.

Additional Contributions: Dennis West, PhD, and Pranathi Lingam, MD, Department of Dermatology, Northwestern University Feinberg School of Medicine, assisted with study design and institutional review board protocols. They were not compensated for their contributions.